Healthcare Provider Details

I. General information

NPI: 1699407809
Provider Name (Legal Business Name): LOURDES CONTRERAS COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 MAPLE AVE
FORT PIERCE FL
34982-5949
US

IV. Provider business mailing address

761 SW JASLO AVE
PORT SAINT LUCIE FL
34953-3940
US

V. Phone/Fax

Practice location:
  • Phone: 772-245-0048
  • Fax:
Mailing address:
  • Phone: 646-314-2705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LOURDES CONTRERAS
Title or Position: OWNER
Credential: LCSW
Phone: 772-245-0048